Sixty Second Interview with Nancy Kelley

The Refugee Council called for the government’s policy of charging asylum seekers whose claims have failed for secondary healthcare to be scrapped last week arguing that it is having a devastating effect. Amy Taylor talks to Nancy Kelley, Head of UK and International Policy at the charity about its new research on issue.

You have called for the government’s policy of charging asylum seekers whose claims have failed for secondary healthcare to be scrapped. Why is this necessary and why should this group not be charged for care?

There are thousands of people living in the UK whose asylum claims have been refused but who are terrified of returning to their country of origin. They come from countries like Somalia, Iran, Iraq, China: countries where human rights abuses are well documented, or where war and instability makes everyday life dangerous. There are more than five and a half thousand people who even the government accepts cannot be returned (those on s4 support). At the moment, these people cannot access hospital care unless they can pay yet they are all either entirely destitute or living on s4 vouchers. The NHS is not a branch of the UK Immigration Service: it was set up to provide universal access to free healthcare to those in need and destitute asylum seekers whose claims have been rejected are exactly that.

You warn that people with serious health needs who have experienced being charged for care may not seek further treatment due to the costs. What could the consequences of this be?

In the worst case scenario, death, in most cases a serious deterioration in health and wellbeing: after all, we are talking about hospital care. For example, under the regulations, HIV testing and counselling is free, but treatment is available only to those who can pay for the drugs themselves.Asylum seekers whose claims have been rejected are told they are HIV positive, then left to wait for the onset of AIDS unless they can pay for their own treatment.

Your report includes people who were denied treatment for cancer and diabetes and maternity care. Could you discuss the circumstances of some of these cases.

We have worked with several people who have cancer, and have been told they must pay if they want operations or radiotherapy. The cases in the report concern people with bowel and stomach cancer, which even with treatment, have relatively low survival rates (50, and 40% respectively). We’ve worked with 17 women denied access to maternity care, including mothers as young as 15. We’ve also worked with people in renal failiure denied treatment, and people recovering from trauma, including torture and rape.

The report says that government guidance stipulates that maternity services should not be free to asylum seekers whose claims have failed but that they should not be withheld if they are unable to pay in advance. However, you found that such services were being witheld to a number of women in this situation. Is this alarming?

Extremely. It is clear that in some trusts at least, women are being asked to pay in advance for their maternity care, and even given payment schedules. The regulations state that this should never happen, in light of risks for both mothers and babies. In fact, we have worked with several women who have given birth at home, without medical care, as a consequence of this failure to apply the policy.

Does this confusion about charging policies for care extend beyond maternity services?

It appears that in some cases, GP surgeries are wrongly assuming that the regulations apply to primary as well as secondary healthcare. Registering with a GP was already extremely hard for asylum seekers, particularly those whose claims have been rejected, but confusion about these regulations seems to be making this even harder.

The report talks about health services passing on asylum seekers’ unpaid medical bills to debt collection agencies who then chase them for payment.What influence does this have on asylum seekers’ health?

We have seen clients who cry from the stress of their situation, other clients dissappearing and going underground. Some charging letters clearly threaten to both pass the debt to a collection agency and threaten legal action. There have been a few instances of trusts telling patients that as a consequence of the debt, the Home Office will make sure they can never re-enter the UK. Its deeply saddening to see a service as wonderful as the NHS taking on this role.

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